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USMLE Reproductive > Breast > Flashcards

Breast Flashcards

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USMLE® Step 1 flashcards
1
Q

When is fibrocystic change most common?

A

premenopausal females

- 20 -50 years old

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2
Q

What are 2 major subtypes of fibrocystic change?

- What are the features of each?

A

Sclerosing adenosis
- Acini and stromal fibrosis, associated w. calcifications

Epithelial hyperplasia
- Cells in terminal ductal or lobular epithelium

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3
Q

What subtype of fibrocystic change disease is more likely to result in cancer?

A 
Epithelial hyperplasia (incr risk of carcinoma w. atypical cells)
- Sclerosing adenosis, slight incr risk
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4
Q

What are the 2 types of inflammatory benign breast diseases?

A
  • Fat necrosis

- Lactational mastitis

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5
Q

What will fat necrosis show on mammography and biopsy?

A

Mammography - calcified oil cyst

Biopsy - Necrotic fat and giant cells

Giant oily block of cheese

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6
Q

What are the the benign tumours which affect the breast?

A
  • Fibroadenoma
  • Intraductal papilloma
  • Phyllodes tumour
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7
Q

What ducts are affected in Intraductal papilloma, mastitis/abcess, paget disease?

A

Lactiferous duct and Major duct (distal)

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8
Q

DCIS + carcinoma, LCIS + carcinoma and fibrocystic change affect what ducts?

A

Terminal duct and lobular unit (proximal)

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9
Q

What breast diseases affect the stroma?

A
  • Fibroadenoma
  • Phyllodes tumor

Sclerosing adenosis affects acini and stroma

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10
Q

When is fibroadenoma most common?

A

< 35 years old

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11
Q

What bacteria causes lactational mastitis?

A

S. aureus - come thru cracks in nipple

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12
Q

What percentage of those with fat necrosis report trauma?

A

50%

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13
Q

Who is most commonly affected by fibroadenoma?

A

< 35years old

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14
Q

Describe the features of a fibroadenoma presentation

A

Small, well-defined, mobile mass in < 35 year old female

- Increased size and tenderness with incr estrogen

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15
Q

What benign tumours are associated with cancer what is less so?

A
  • Fibroadenoma = not increased risk
  • Intraductal papilloma = slight increase
  • Phyllodes tumour = Some may become malignant
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16
Q

What is fibroadenoma (benign tumour) composed of?

A

Fibrous tissue and glands

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17
Q

What is the most common cause of nipple discharge serous or bloody?

A

Intraductal papilloma

18
Q

Describe Intraductal papilloma (benign tumor)

A

Small fibroepithelial tumour w. lactiferous ducts typically beneath areola

19
Q

Describe Phyllodes tumour (histo)

A

Large mass of connective tissue (stroma) and cysts with ‘leaf-like’ lobulations

20
Q

Who is most commonly affected by Phyllodes tumour?

A

Woman in 40s

21
Q

What quarter of the breast is most commonly affected by breast cancer?

A

Upper outer

22
Q

What are the receptors which can be amplified/overexpressed in breast cancer?

A
  • Estrogen receptor
  • Progesterone receptor
  • c-erB2, HER2 - an Epidermal Growth Factor Receptor (EGFR)
23
Q

What type of breast cancer is most aggressive in terms of receptors?

A

Triple negative

24
Q

How is DCIS usually detected?

A

Macrocalcifications on mammography

- Usually does not produce a mass

25
Q

What is Comedocarcinoma, what is it a subtype of? What is seen on histology?

A

A subtype of DCIS

- Cells have high-grade nuclei w. extensive central necrosis and dystrophic calcification

26
Q

What is seen on histology in DCIS?

A

Cells filling ductal lumen, neoplastic cells that engorge blood vessel
- Arises from ductal atypia

27
Q

What is the most common type of invasive breast cancer?

A

Invasive ductal carcinoma

28
Q

What is the pathophysiology of Paget’s disease?

A

Extension of underlying DCIS/invasive breast cancer up to lactiferous duct ands and into contigous skin of nipple from terminal duct/lobular unit

29
Q

What will Paget’s disease look like?

A

Eczematous patches over nipple and areolar skin

30
Q

Lobular carcinomas / LCIS lack what molecule?

A

E-cadherin

31
Q

What does a lack of E-cadherin result in in histology in Lobular carcinomas / LCIS?

A

Orderly row of cells ‘single file’ and no duct formation

  • Lines of cells
  • Often bilateral w. multiple lesions in the same location
32
Q

What response do invasive lobular carcinoma lack?

A

Desmoplastic response

33
Q

What can a medullary carcinoma mimic?

A

A well-circumscribed tumour can mimic fibroadenoma

34
Q

What will be seen on histology in medullary carcinoma?

A

Large, anaplastic cells growing in sheets w. associated lymphocytes and plasma cells

35
Q

Describe Inflammatory breast cancer

A

Dermal lymphatic space invasion -> breast pain w. warm, swollen, erythematous skin around exaggerated hair follicles (peau d’orange’)

36
Q

What type of breast cancer can lack a palpable mass?

A

Inflammatory

37
Q

Name the ducts of the breast from the nipple to the lobular units

A

Lactiferous duct -> Major duct -> Terminal duct

-> Lobular unit (surrounded by stroma)

38
Q

What is a stereotypical presentation of fibrocystic change disease?

A

Premenopausal woman 20-50

- Premenstrual breast pain or lumps

39
Q

Describe invasive ductal carcinoma?

A
  • Firm, fibrous “rock-hard” mass with sharp margins and - Small, glandular, duct-like cells in desmoplastic stroma
40
Q

Differences between invasive ductal and invasive lobular?

A
  • Lobular does not have ducts
  • Lobular has decreased E-cadherin, single-file orderly row of cells
  • Lobular lacks desmoplastic response

USMLE Reproductive (14 decks)

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